Provider Demographics
NPI:1760740740
Name:SINCLAIR, DEANNA L (MHS, OTRL, CLT, CAPS)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:MHS, OTRL, CLT, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 BAY HILL DR
Mailing Address - Street 2:APT 14
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6602
Mailing Address - Country:US
Mailing Address - Phone:231-633-6988
Mailing Address - Fax:231-421-8088
Practice Address - Street 1:335 W SOUTH AIRPORT RD
Practice Address - Street 2:STE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4886
Practice Address - Country:US
Practice Address - Phone:231-633-6988
Practice Address - Fax:231-421-8088
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004034225X00000X, 225XE0001X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5867Medicare UPIN